Personal Information. Last Name First Name Middle Name

Transcription

1 Personal Information Last Name First Name Middle Name Gender: M F CU Student ID # Sophomore Junior Senior of Birth: (mm) / (dd) / (yyyy) Country of Birth: Country of citizenship: Place of birth (city, state): Passport #: Country of Issue: Expiration date: University Information School: Business Education Humanities & Social Sciences Natural Sciences & Mathematics Major: Minor: Expected semester and Year of Graduation: Contact Information Home Address: Permanent home phone: ( ) Address Cell phone: ( ) Personal Campus Mailing Address: Address below is on campus off campus. Personal campus phone: ( ) Summer Address: Would you like to live on campus upon your return? Yes No If yes, residence hall name Not applicable

2 Parent/Legal Guardian Contact Information Father s Name Street address City or town State / Zip Code Home phone number ( ) Work phone number ( ) Do not contact. Mother s Name Street address City or town State / Zip Code Home phone number ( ) Work phone number ( ) Do not contact. Person to be notified in case of emergency? Father Mother Other* Person to receive billing statements? Father Mother Other* *If you have checked Other for either of the previous questions, please complete the following to be used for emergency billing: Name Relationship Home Phone ( ) Work Phone ( ) Name of country and university to be visited City, state, country:,, Study abroad period: Fall Spring Full Year Summer Beginning date: Ending date:

3 Financial Aid Clearance Certification and Other Required Signatures Students who study abroad must comply with the same financial aid procedures that they follow when studying on campus at Claflin University. Final approval by Claflin University to study abroad is not granted without completion of these requirements. A stamped, approved course schedule and a copy of the Financial Aid Award Letter must be attached to this document. Students are responsible to cover any difference between the total amount of financial aid and the total amount needed to study abroad (transportation, health insurance, books, etc.) Student Signature Director, International Studies (Name of student completing this application) has financial aid and/or scholarship funding, and Claflin University will pay $ towards the final bill for the proposed study abroad experience. Financial Aid Administrator The information in this application is complete and correct to the best of my knowledge. The application process may include supplementary materials, which I agree to complete promptly. If accepted into the Study Abroad Program, I will participate in all required orientation meetings, and complete all evaluations. I give permission to the Office of International Studies (OIS) to send my parent(s) or guardian(s) any information deemed appropriate by the OIS. I also authorize the Registrar to release my transcript to the OIS as part of this application, and the OIS to forward transcripts and other information, as appropriate, to the overseas studies program(s) to which I am applying. I understand that any action on this application is contingent on review of all of my Claflin University grades, and my complete academic and disciplinary records through the time of departure for the program. I further understand that a change in my academic status or an academic (including Honor Code) or disciplinary violation or sanction prior to my departure overseas may result in the withdrawal of support for my nomination. I understand that weekly contact by with the director of international studies is expected. Academic Advisor or Department Chair Office of Fiscal Affairs Office of Residential Life Director, Alice Carson Tisdale Honors College (only if applicable) Office of the Provost

4 Disciplinary Clearance The student named below has no past or pending disciplinary issues that would prevent their successful completion of a study abroad program. It is understood that disciplinary problems that arise any time prior to departure to the study abroad program site may constitute grounds for exclusion from the program. Any financial loss incurred due to such a cancellation would need to be assumed by the student. (student name) is applying to study abroad during the (semester, year). Does this student have a disciplinary record with Claflin University? No Yes, and an official document or copy stating the details is enclosed If you have any additional comments, you may write them here or attach a separate sheet of letterhead. Approval for this document Vice President for Student Development and Services

5 Required Documents Summary Students wishing to study abroad must submit the following required documents to the Office of International Studies, with all appropriate signatures in the official application folder provided by the Office of International Studies prior to travel. Please note that Claflin University is committed to compliance with all guidelines, policies, and procedures relevant to submission of applications and required documents for study abroad experiences to our partner institutions Required documents include: Registration worksheet (with required approval signatures) Financial Aid Clearance Certification (with required approval signatures) Disciplinary Clearance Form (with required approval signature) Supplementary Insurance Documentation (EIIA covers anyone from CU that travels abroad) Stamped, approved course schedule for the semester in which travel occurs Copy of the Financial Aid Award Letter Claflin University Application for Study Abroad (this entire document) Approval entire document Director, International Studies Student